ATTORNEYS FOR APPELLANT ATTORNEYS FOR APPELLEES ATTORNEYS FOR AMICUS CURIAE
Michael L. Hanley BALL MEMORIAL HOSPITAL IND. STATE MEDICAL ASSOC.
Vernon J. Petri & Assoc., AND ROBERT HUNTER, M.D. Linda J. Cooley
Indianapolis, Indiana Mary K. Reeder Libby Y. Mote
Pamela G. Schneeman Krieg DeVault, LLP
Mary A. Findling Riley Bennett & Egloff, LLP Indianapolis, Indiana
Findling Garau Germano Indianapolis, Indiana
& Pennington, P.C.
Indianapolis, Indiana ATTORNEY FOR APPELLEE
LAWRENCE BENKEN, M.D.
James W. Brauer
Stewart & Irwin, PC
Indianapolis, Indiana
_____________________________________________________________________________
In the
Indiana Supreme Court
_________________________________
No. 49S02-0412-CV-501
MARSHA LEDBETTER, Appellant (Plaintiff below),
v.
ROBERT HUNTER, M.D.,
LAWRENCE BENKEN, M.D., AND
BALL MEMORIAL HOSPITAL Appellees (Defendants below).
_________________________________
Appeal from the Marion Superior Court, No. 49D02-9409-CT-384
The Honorable Kenneth H. Johnson, Judge
_________________________________
On Petition To Transfer from the Indiana Court of Appeals, No. 49A02-0309-CV-770
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February 22, 2006
Dickson, Justice.
In this appeal following the trial court's dismissal of the plaintiff's complaint alleging
medical negligence, the Court of Appeals concluded that the Indiana Medical Malpractice Act's
statute of limitations regarding claims of minors violated the Privileges and Immunities Clause
of the Indiana Constitution. Ledbetter v. Hunter, 810 N.E.2d 1095, 1103 (Ind. Ct. App. 2004).
We granted transfer, thereby automatically vacating the opinion of the Court of Appeals, and
now deny the plaintiff's claim that the challenged statutory provision is unconstitutional.
This lawsuit seeks damages for injuries to Trenda Ledbetter, who was born at defendant
Ball Memorial Hospital on November 25, 1974, with birth complications causing serious and
permanent physical and mental injuries. For religious reasons, Trenda's mother did not assert a
malpractice claim on behalf of her daughter. On April 22, 1994, less than two years after her
eighteenth birthday, Trenda filed a medical malpractice claim against the hospital and defendants
Robert Hunter, M.D. and Lawrence Benken, M.D., the physicians who attended her birth. The
defendants moved to dismiss, contending that the action was not commenced before Trenda's
eighth birthday pursuant to the Indiana Medical Malpractice Act limitations period for claims of
minors. The trial court granted the motion, but the Court of Appeals reversed and remanded to
the trial court for consideration of the constitutionality of the statutory limitation period under the
Privileges and Immunities Clause. Ledbetter v. Hunter, 652 N.E.2d 543 (Ind. Ct. App. 1995),
transfer not sought. Trenda died shortly thereafter, and her mother, Marsha Ledbetter, was sub-
stituted as the plaintiff in this action. After further proceedings, the trial court again dismissed
the action, finding that the plaintiff had failed to demonstrate that the statute was unconstitu-
tional. Appellant's App'x. at 28.
The plaintiff contends that the medical malpractice statute of limitations for minors vio-
lates Article 1, Section 23, of the Indiana Constitution as interpreted by Collins v. Day, 644
N.E.2d 72 (Ind. 1994). Section 23 states: "The General Assembly shall not grant to any citizen,
or class of citizens, privileges or immunities, which, upon the same terms, shall not equally be-
long to all citizens." In Collins, we analyzed the enactment of this provision and synthesized
prior case law, concluding that:
Article 1, Section 23 of the Indiana Constitution imposes two requirements upon statutes
that grant unequal privileges or immunities to differing classes of persons. First, the dis-
parate treatment accorded by the legislation must be reasonably related to inherent char-
acteristics [that] distinguish the unequally treated classes. Second, the preferential treat-
ment must be uniformly applicable and equally available to all persons similarly situated.
Finally, in determining whether a statute complies with or violates Section 23,
courts must exercise substantial deference to legislative discretion.
644 N.E.2d at 80. The first prong itself has two necessary components: "[a] such classification
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must be based upon distinctive, inherent characteristics [that] rationally distinguish the unequally
treated class, and [b] the disparate treatment accorded by the legislation must be reasonably re-
lated to such distinguishing characteristics." Id. at 79. Likewise, the second prong is described
as comprising two elements: "[a] any privileged classification must be open to any and all per-
sons who share the inherent characteristics [that] distinguish and justify the classification . . . ,
[and] [b] the special treatment accorded to any particular classification [must be] extended
equally to all such persons." Id.
We cautioned in Collins that, in applying the two-prong standard, courts "must accord
considerable deference to the manner in which the legislature has balanced the competing inter-
ests involved," id. at 80, that "[s]o long as the classification is based upon substantial distinctions
with reference to the subject matter, we will not substitute our judgment for that of the legisla-
ture[,] nor will we inquire into the legislative motives prompting such classification," id. (quot-
ing Chaffin v. Nicosia, 261 Ind. 698, 701, 310 N.E.2d 867, 869 (1974)), and that a challenger
must "negative every conceivable basis which might have supported the classification," id. (quot-
ing Johnson v. St. Vincent Hosp., Inc., 273 Ind. 374, 392, 404 N.E.2d 585, 597 (1980)).
Nevertheless, Collins clearly emphasized our anticipation that "our independent state
privileges and immunities jurisprudence will evolve in future cases facing Indiana courts to as-
sure and extend protection to all Indiana citizens." Collins, 644 N.E.2d at 81. Although we ex-
plicitly noted that preferential legislative treatment that was proper when enacted "may later
cease to satisfy the requirements of Section 23 because of intervening changes in social or eco-
nomic conditions," a challenger must carry its burden to negate every reasonable basis for the
classification. Id.
The plaintiff challenges the constitutionality of the limitation period in the Indiana Medi-
cal Malpractice Act, which states:
A claim, whether in contract or tort, may not be brought against a health care provider
based upon professional services or health care that was provided or that should have
been provided unless the claim is filed within two (2) years after the date of the alleged
act, omission, or neglect, except that a minor less than six (6) years of age has until the
minor's eighth birthday to file.
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Ind. Code § 34-18-7-1(b). 1 The plaintiff points to the fact that this statute of limitations for mi-
nor victims is two years, or until age eight if injured in the first six years of life, in contrast to
minor victims of other torts, who have until two years after the age of majority to file suit. Ind.
Code § 34-11-6-1. She argues that the first prong of Collins is thereby violated because the Act,
without a legitimate basis, creates "two unequally treated classes: 1) those children injured by
medical malpractice; and 2) those children injured by negligence other than medical malprac-
tice." Br. of Appellant at 10. In addition, the plaintiff separately asserts that the second prong is
violated because the Act's statute of limitations treats differently two subclasses of minor victims
of medical malpractice: "1) those with parents who seek legal advice and file a claim; and 2)
those with parents who chose not to do the same." Id. at 11.
As to the first prong, we find dispositive the plaintiff's failure to negate the legislative
basis for unequal treatment of the two identified classes. Although acknowledging that the Act's
statute of limitations as it applies to minors was specifically found to be constitutional in St. Vin-
cent Hosp., the plaintiff argues that minors' medical negligence claims have an insignificant im-
pact upon the availability of healthcare statewide and that a change in the statute of limitations
does not risk the availability of health care services. Br. of Appellant at 16-18. Before the trial
court, the plaintiff served nonparty requests for production upon numerous medical malpractice
insurance carriers and upon the Indiana State Medical Association and the Indiana Hospital As-
sociation seeking information regarding "what significance, if any, the statute of limitations for
minors had on the affordability of medical malpractice insurance and the consequent availability
of health care services." Br. of Appellant at 17. The plaintiff emphasizes that "neither the insur-
ance carriers nor the health care associations could produce a single document showing that a
change in the disability provision for minors in medical malpractice cases would have any ad-
verse effect on the cost of insurance, the availability of health care services, or the ability to de-
fend malpractice claims." Br. of Appellant at 20.
In St. Vincent Hosp., this Court expressly rejected a challenge to the Act's classification
of the claimants by age, concluding that the purpose of the Act, "to protect the health of citizens
of this State by preventing a reduction of health care services," 273 Ind. at 392, 404 N.E.2d at
1
Formerly Ind. Code § 27-12-7-1(b).
4
597, is "furthered in a rational manner by limiting the legal disability of infants to those under six
years of age, and the classification of those entitled to legal disability by age and type of claim
bears a fair and substantial relationship to that same end." Id. at 405, 404 N.E.2d at 604. We
decline to overturn this determination based upon the defendants' failure to affirmatively provide
documentary proof to support the rationale used in St. Vincent Hosp. When challenging a statute
as invalid under Section 23, it is the challenging party who has the burden to negate "every rea-
sonable basis for the classification." Collins, 644 N.E.2d at 81. Demonstrating a lack of sub-
stantial evidence supporting a legislative rationale does not affirmatively establish that the ra-
tionale is unreasonable.
The inference from this lack of information, if true, may well provide powerful support
for legislative reconsideration of the challenged minor limitation period. But a statute is not un-
constitutional simply because we might disagree with the legislature about the wisdom of the
statute. State v. Rendleman, 603 N.E.2d 1333, 1334 (Ind. 1992).
The plaintiff separately contends that the limitation period for minors violates Section 23
because Trenda Ledbetter, a part of the class of children injured by medical malpractice, was
also part of a subclass of minors whose parents fail or choose not to timely assert medical mal-
practice claims, in contrast to those parents who seek legal advice and timely file claims. The
plaintiff asserts that this constitutes a violation of the second prong of Collins, which requires
that the unequal privileges or immunities granted by statute to differing classes of persons be of
uniform applicability and availability to "all persons who share the inherent characteristics [that]
distinguish and justify the classification. Collins, 644 N.E.2d at 79.
But the two subclasses alleged by the plaintiff, based upon whether a child's parents
timely assert the child's medical malpractice claim, are not treated differently by the statute. The
unequal special privileges or immunities, or special treatment, accorded minor children injured
by medical malpractice is that they are subject to specific time limitations within which to file
claims (within two years of the occurrence or until their eighth birthday, if injured anytime be-
fore their sixth birthday). Such special treatment, the limitation regime imposed by the Act,
definitely is applicable equally to all who share the distinguishing inherent characteristic of being
5
minor victims of medical malpractice. The children in each of the plaintiff's alleged subclasses
share the same statute of limitations regime, with different results occurring only based upon
whether or not the child, through her parents, elects to comply with the statutory deadlines.
Medical malpractice claims may be equally presented on behalf of any child injured by medical
malpractice simply upon the initiation of the claim within the statutory time limit.
Under Indiana law, custodial parents are authorized to act on behalf of their minor chil-
dren for the purpose of consenting to health care. Ind. Code §§ 16-36-1-3,-5, 29-3-3-3(8). Par-
ents are likewise designated to maintain actions for injuries to their child caused by the wrongful
act or omission of another. Ind. Code § 34-23-2-1. "The responsibility to learn of a child's inju-
ries and to recognize that they may have been caused by the tortious act of another must fall to
parents and legal guardians." Fager v. Hundt, 610 N.E.2d 246, 251 (Ind. 1993). Noting the
"natural and legal obligations of parents to protect and care for their children," this Court has im-
puted to a child, for the purpose of accrual of a cause of action, their parent's knowledge of facts
regarding their child's injury. Id. While Fager involved application of the general limitation pe-
riod allowing a minor two years after reaching majority in which to commence suit, its rationale
is equally applicable here.
The plaintiff's contention regarding the second prong of Collins is thus equivalent to al-
leging that each statute of limitation violates Section 23 because, within the class of persons sub-
ject to such a statutory limitation period, there are two classes of persons unequally treated—
those who timely commence an action and those who fail or choose not to. The second prong
does not prohibit such a distinction.
In considering challenges to the constitutionality of a statute, we accord it "with every
reasonable presumption supporting its validity and place the burden upon the party challenging it
to show unconstitutionality." St. Vincent Hosp., 273 Ind. at 381, 404 N.E.2d 591. Any claimed
fatal constitutional defects must be "clearly apparent." Id. All doubts are resolved against the
party challenging the constitutionality of a statute. State v. Rendleman, 603 N.E.2d 1333, 1334
(Ind. 1992). The presumption of constitutionality continues unless "clearly overcome" by a con-
trary showing. Id.
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We conclude that the plaintiff has failed to overcome the presumption of constitutionality
that must be accorded the Medical Malpractice Act limitation period for minors. Transfer having
previously been granted, we affirm the trial court judgment dismissing this action.
Shepard, C.J., and Sullivan, Boehm, and Rucker, JJ., concur.
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